The protesters had pretty good singing voices, Beverly Mackereth had to admit. And with all the grace she could muster, Pennsylvania's secretary of public welfare gamely tried to include them as she swung through Pittsburgh to pitch Gov. Tom Corbett's controversial Medicaid reform proposal.
"Their theme was, 'We need better coverage,' " she said Friday morning at the Allegheny County Courthouse. "And that's our goal."
Ms. Mackereth visited Downtown for the second stop of a journey across the state to collect public comments on Mr. Corbett's "Healthy Pennsylvania" plan, which the Republican governor is pushing in lieu of a Medicaid expansion offered by the federal Affordable Care Act.
From the courthouse lobby, she was serenaded by a few dozen protesters from the Cover the Commonwealth Coalition, who say the governor's plan slashes Medicaid benefits and makes it harder to apply for help. In a musical twist on "Jingle Bells," they asked Mr. Corbett to "do the right thing."
"This is not Medicaid expansion -- this is something different," said Neal Bisno, president of SEIU Healthcare PA, who spoke at both the rally and the more sedate public comment session upstairs.
Under the Affordable Care Act, half a million Pennsylvanians would have become eligible for Medicaid, the government-run health insurance system for the poor and disabled. Empowered by a Supreme Court ruling, Mr. Corbett turned down that expansion and is looking to use federal funding to pay for private plans instead.
Earlier this month, he introduced a larger Medicaid reform proposal, one that would eliminate most co-pays but require monthly premiums for participants making more than 50 percent of the federal poverty rate. He's also looking to enact a work search requirement, which would give coverage to the unemployed only as long as they register on a career site and move toward finding a job.
Critics say the governor's plan will put the health of poor Pennsylvanians at risk, comparing his work requirement to denying poor children free lunches at school if they don't get As in class.
In the three-hour session, about 30 advocates, opponents and residents gave their say on the proposal, which is still under revision. Several disability rights activists were disappointed about cuts in Medicaid benefits; other speakers complained the new sign-up requirements could put some folks on the wrong plans.
Susan Kalson, CEO of the Squirrel Hill Health Center, told Ms. Mackereth she fears that changes to reimbursement rates and other reforms could make her clinic unaffordable for its poorest clients.
"Access to insurance does not equal access to care," she said. "We're very concerned this is going to turn evidence-based best practice on its head."
Most agreed that the proposal, which must be approved by the federal government, is not an easy document to digest. With the document weighing in at more than 200 pages, health care advocates say they're still combing through it for changes.
But not everyone was against Mr. Corbett's plan. Amanda LaPorte, regional director of operations for HCR-ManorCare, said the proposal rightly keeps Medicaid centered on the state's hardest-luck cases.
"The governor's Healthy PA ensures the frail elderly remain a priority by keeping limited Medicaid dollars for older Pennsylvanians and tapping into the private insurance marketplace for the expansion of health care to those who are uninsured," Ms. LaPorte testified in a prepared statement. "That's good for Pennsylvania's seniors."
The Corbett administration's struggles with Medicaid comes down to dollars: The governor does not believe the plan advanced by the Affordable Care Act is fiscally sustainable. Medicaid already covers one in six Pennsylvanians; Its annual $20 billion price tag grows by $300 million to $400 million each year, Ms. Mackereth said.
Enter her focus on the private insurance market, which she believes is in a better position to take care of the indigent. If the governor's plan is approved, federal dollars slated to expand those covered by Medicaid will instead help poorer residents receive private insurance.
Some health care advocates said that's a step in the right direction: Mr. Corbett had originally appeared ready to turn down all extra funding altogether. But multiple speakers said the governor is delaying relief for more than 500,000 residents, who they say would receive insurance this January if the governor accepted Medicaid expansion instead of plowing his own way.
Ms. Mackereth doubts that, saying any action on Medicaid would require thousands of new hires and take time to ramp up.
And she doubts the state -- or the caroling protesters -- would like the bill that would eventually come due.
"We want to keep Medicaid for our most vulnerable so we don't blow it up," she said.
Andrew McGill: firstname.lastname@example.org or 412-263-1497.